Naked Truth: Why Women Shrug Off Lousy Sex

For some couples, the answer might be a resounding yes. But for many women, a lack of sexual desire or pleasure isn't worth getting worked up about. Studies find that while one-third to nearly one-half of women report sexual function problems, only about 10 percent are worried about those troubles.

Unsurprisingly, the 10 percent of women who experience both problems with desire and stress about sexual function have received the bulk of the research attention — they're the ones with real problems, after all. But studies on the happily dysfunctional might provide hints into the factors that influence sexual distress. (The results could also give these women a hint of what they were missing.)

"We've assumed for so long that for both men and women, these problems were always depressing," Kyle Stephenson, a University of Texas at Austin doctoral candidate in psychology who recently published a paper on the topic, told LiveScience.

When survey data proved that notion wrong, Stephenson said, the question became, "What happens within the confines of a sexual relationship that makes these problems so distressing you want to seek treatment?" [Related: 5 Myths About Women's Bodies]

The dysfunction gap

Sexual problems are common in both genders. A 1999 study of sexual dysfunction in the United States, published in the Journal of the American Medical Association, found that 43 percent of women and 31 percent of men reported sexual problems. It's the flavor of those problems that tends to differ, said Sheryl Kingsberg, a psychologist at the Case Western Reserve University School of Medicine in Cleveland, Ohio.

"For women, the biggest problem is going to be desire," Kingsberg told LiveScience.

Men, on the other hand, tend to experience problems with the plumbing: premature ejaculation in young men and erectile dysfunction in older men.

Compared with the stew of physical, psychological and cultural factors that make up desire, erectile dysfunction and premature ejaculation are a breeze to treat. The common male problems are also easier to diagnose. Want to have sex but can't maintain an erection? That's erectile dysfunction. Don't have the desire to have sex? Well, maybe you're tired. Or stressed. Or in a bad relationship. Or experiencing medication side effects.

Compounding the confusion is the fact that women's subjective experiences of sex may not match up with their physical sexual response. A 2008 study of more than 31,000 women, published in the journal Obstetrics and Gynecology, found that while 43 percent of women reported having sexual problems, only about a quarter cared.

And female patients and doctors don't always agree on sexual setbacks. For instance, researchers found that 10 percent of the 436 English women (ages 35-59) studied felt they had sexual problems. However, as reported in 1988 in the British Medical Journal, a third of those didn't meet the researchers' criteria for sexual dysfunction. (That study found that overall 33 percent of participants met criteria for sex problems.)

A similar result popped up in 1998, when a study published in the journal Family Practice reported that 39 percent of the female respondents were interested in seeking help for their sexual problems, but only half of that 39 percent actually had problems by the researchers' reckoning.

Putting sex in context

Part of the reason dysfunction and distress don't match up, said Leonard Derogatis, the director of the Center for Sexual Medicine at Sheppard Pratt Health System, is that the average woman's sexual desire is more contextual than a man's.

"Women might be having sex for a dozen different reasons, only one of which might be that it feels good and is satisfying," Derogatis told LiveScience. "It's a path to intimacy, it's a path to fulfilling a role of the woman or wife, it's a means to keeping her partner happy, and on and on."

That context is what Stephenson and his co-author and adviser, UT Austin psychologist Cindy Meston, were interested in investigating. They asked 200 heterosexual undergraduate women to complete questionnaires about their relationship quality and sexual satisfaction. The results, published in August in the Journal of Sexual Medicine, suggest a woman's approach to relationships, as well as her level of intimacy with her partner, influence how distressing she'll find sexual problems.

The researchers went into the study predicting that in intimate relationships marked by trust and openness, sexual problems would be less distressing. That turned out to be true only to a point, Stephenson said. Only women who were anxious about their attachment to their partners found intimacy soothing in the face of sexual dysfunction. In women with secure attitudes about their relationships, extra intimacy didn't help.

It may be that women who are anxious about their relationship are so relieved to have intimacy, they ignore problems in bed, Stephenson said. The women who are secure, on the other hand, might put a higher priority on sex.

When the researchers set aside other sexual problems and looked at low sexual desire alone, however, they found that intimacy did protect against distress. That could be because women in intimate relationships are experiencing closeness in nonsexual ways, Stephenson said, or it could be that when they tell they're partner they're not in the mood, he's more understanding.

Stephenson is now collecting preliminary data to try to understand what happens on a case-by-case basis when a woman has problems with sexual functioning. Does her partner get frustrated? Do they end up having less sex? And how are those consequences tied to her experience of distress?